DME Nurse Case Manager
A Durable Medical Equipment (DME) nurse case manager is responsible for coordinating with medical providers, injured workers, and carriers through the management of the DME process. The goal of the case manager is to facilitate DME needed for medical purposes by patients for self-care in a home setting.
Job Duties and Responsibilities
- Requests for prior authorization of DME
- Review provider requests by telephone or through fax to ensure medical necessity for services that require pre-authorization
- Assist in ordering medical equipment needed for patient during recovery from surgery or for long-term use
- Apply nationally recognized criteria to determine medical necessity of services requested
- Refer provider requests appropriately to the medical director when medical obligation of services is not met based on criteria
Education and Qualifications
- High school diploma or GED equivalent
- Possess good communication skills
- Attention to detail
- Must have previous DME/Utilization Review/Prior Authorization experience
- Management experience is preferred
- Must be computer proficient: Microsoft Office, Word, and Excel, typing skills 30 WPM or above